Information on how to deal with menstrual problems in teens with disabilities has been limited, according to lead author Elizabeth Jeffery, MBCHb (HONS), PhD, a Warrington and Halton Hospitals NHS Trust trainee, and colleagues.

For their study, Dr. Jeffery and her fellow researchers reviewed the emotional and behavioral changes associated with monthly periods in teens with physical and learning disabilities.

Menstrual symptoms in girls with disabilities included aggression, restlessness, hyperactivity and increased agitation. Self-mutilation was also common, according to the researchers.

The researchers said these menstruation-related conditions were unique compared to symptoms of the rest of the population and could significantly disrupt the girls' lives.

Up to 18 percent of adult women with disabilities had premenstrual syndrome (PMS), compared with 5 percent of women in the general population, the researchers found.

PMS can cause cramps, acne, breast swelling and tenderness, as well as mood swings and irritability.

The decision to be treated should rest on a multi-disciplinary team with the patient and her family, the researchers said.

"Managing the menstrual problems of girls with disabilities represents a challenging medical dilemma, however, not all adolescents with disabilities will encounter problems," said Anne Garden, MD, head of Lancaster Medical School and co-author of the study, in a press release.

Medical treatments can help girls manage their menstrual problems in most circumstances, according to the researchers.

Treatments include the combined oral contraceptive pill, the combined transdermal patch, the progestogen-only pill and implanon, a matchstick-sized rod that's inserted into the arm to prevent pregnancy.

The researchers suggested that if medical management fails, permanent surgical procedures should be considered as a last resort.

Surgical options include endometrial ablation, which destroys a small layer of the lining of the uterus, and hysterectomy, or removing the uterus entirely.

The review also covered menstrual management and hygiene concerns of parents and caregivers. These concerns included the girls' vulnerability to sexual abuse, pregnancy and inappropriate behavior, particularly for girls in residential care.

"Adolescents with disabilities are more likely to have menstrual problems than the general female population," the researchers wrote in their report. "However, this is not to say that all adolescents with disabilities will encounter problems and often parental and caregiver concerns do not transpire."

The study was published April 19 in The Obstetrician & Gynaecologist.

One of the authors is a joint editor and contributor of the book Paediatric and Adolescent Gynaecology for the MRCOG and Beyond. Funding information for the study was not available.

Endometriosis

Endometriosis, occurs when tissue that normally lines the uterus grows outside of the uterus on other organs or structures in the body. Endometriosis causes pain in the lower abdomen or pelvis, or the lower back, mainly during menstru...

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